1639112212 NPI number — LORI JANE MILLER RN, WHCNP

Table of content: LORI JANE MILLER RN, WHCNP (NPI 1639112212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639112212 NPI number — LORI JANE MILLER RN, WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LORI
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, WHCNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639112212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 BEAM AVE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
MAPLEWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55109-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-257-9622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 EXCHANGE ST W STE 622
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-297-9141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  R155474-6 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 684421900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07-04740 . This is a "MEDICA PROVIDER ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 519P1MI . This is a "BCBS MN PROVIDER ID #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP62465 . This is a "HEALTH PARTNERS ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1046752 . This is a "PREFERRED ONE ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2435603 . This is a "AMERICA'S PPO ID #" identifier . This identifiers is of the category "OTHER".




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